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NOVEMBER 2011
Children around the world are doing better than ever, according to a new report from UNICEF and Save the Children UK. Compared to just a few decades ago, fewer young children are dying each day, fewer children are living in poverty and more children are well-fed and in school. The good news for decision makers is that there seems to be a path to extending these gains: Evidence suggests that they have resulted from strong, explicit national commitments to invest in children, supportive policies, and greater and welltargeted development assistance. Going forward, efforts will have the greatest impact if focused on the most disadvantaged, where childhood deprivation is increasingly concentrated.
The number of children enrolled in preprimary education worldwide increased from 113 million to 157 million between 1999 and 2009.
There are fewer people living in poverty. It is estimated that between 2005 and 2010 the total number of poor people around the world fell by nearly half a billion to under 900 million. A particularly positive feature is that this decline is happening in most regions of the world, though at different speeds. While this aggregate decline can hide widening disparities, children generally benefit from falling poverty rates because they are disproportionately likely to be living in poor households (which tend to have more children than non-poor households). In many countries, children are doing better despite slow economic growth. Achievements in key areas for child development such as reducing child mortality and severe malnutrition, improving access to water and sanitation and increasing the number of children in school have been made even in countries with moderate poverty reduction and slow rates of growth. Evidence suggests that although economic growth is a necessary condition of sustained improvement in health and education indicators and in the quality of social services, the take-off in social development is more closely linked to national commitment, a favourable policy environment and spreading knowledge on effective, targeted and often lowcost interventions such as immunizations or basic sanitation (see Box 2).
Box 2: Progress in water and sanitation in the Lao Peoples Democratic Republic
The Lao Peoples Democratic Republic is classified as a least-developed country and is one of the poorest countries in East Asia. Yet between 1995 and 2008 its average yearly progress in increasing the share of the population with access to improved sanitation was the second highest in the world. Some of the initial gains reflected achievements in broadening knowledge about basic sanitation, and consequent private household investments supported by rising incomes. Sanitation initiatives in the past decade have focused on the poorest districts, mostly in rural areas. The Government has also adopted a policy and toolkits to better target poorer and marginalized groups in project design and implementation.
Reasons for this progress include more educated girls, greater investment in healthcare systems, improved nutrition for mothers, better infant and young child feeding practices, effective preventive approaches (including preventing mother-to-child transmission of HIV) and increased access to safe water and sanitation.
Moreover, equitable approaches to, for example, education and access to land have underpinned later advances in social development. There has been improvement in childrens nutrition around the world, though the pace of progress has varied. Stunting (damage to childrens physical and cognitive development as a result of chronic early under-nutrition) declined in developing countries from 40 per cent to 29 per cent between 1990 and 2008. Underweight prevalence among children under five also went down especially in Latin America and the Caribbean where it fell from 11 per cent in 1990 to 6 per cent in 2008. There have been successes in tackling micronutrient (vitamin A, iodine and iron) deficiencies too. Fewer people are becoming infected with HIV and fewer people are dying of AIDS. Thirty years of investment in preventing and treating HIV is paying off. Further, there has been significant progress in preventing HIV among children globally there was a 24 per cent decline in newly infected children and a 19 per cent decline in children dying from AIDS between 2004 and 2009. One success story is Botswana, a country with high HIV prevalence (see Box 3).
gained access to improved sanitation (from 54 per cent to 61 per cent). The greatest progress has been in North Africa. Poor sanitation, water and hygiene are major factors in child health, with diarrhoea killing as many children under five as AIDS, malaria and measles combined. More children are in pre-school. The number of children enrolled in pre-primary education worldwide increased from 113 million in 1999 to 157 million in 2009, mostly because of gains in South and West Asia and, to a lesser extent, sub-Saharan Africa and Latin America and the Caribbean. A few countries such as Chile (see Box 4) have either universalized services or developed special initiatives to provide early childhood development programmes in remote rural areas.
More people have access to improved water and sanitation. Between 1990 and 2008, 1.8 billion more people worldwide gained access to improved drinking water an increase from 77 per cent of the worlds population to 87 per cent. Over the same period, 1.3 billion people
More children are in primary and secondary school including more girls. There has been rapid advance towards the goal of universal primary education (MDG2). From 1999 to 2009 an additional 58 million children enrolled in primary school and the number of out-of-school primary-aged children decreased by 39 million, with 80 per cent of this decline in sub-Saharan Africa and South and West Asia. Survival rates until the last year of primary school have also increased in just over half the low- and middleincome countries for which there are data (26/50) and remained stable in around a third
(15/50), though they have decreased in approximately a fifth (9/50), and completion rates more generally need to be improved particularly for the poor and vulnerable. In addition, the global gender gap in school enrolment has narrowed. Worldwide, girls now make up 53 per cent of the out-of-school population compared to 60 per cent in 1990. The proportion of adolescents of lower secondary age who were out of school fell globally by 21 per cent from 1999 to 2009. Children overall are better protected. Approximately three quarters of States have signed, ratified or acceded to the Optional Protocol to the Convention on the Rights of the Child on the involvement of children in armed conflict, and the Optional Protocol to the Convention on the Rights of the Child on the sale of children, child prostitution and child pornography, thus demonstrating their official commitment to child protection. The Guidelines for the Alternative Care of Children, which have been endorsed by the UN General Assembly, are being aligned with national frameworks and actions to reach children who are in need of or at risk of being in need of alternative care. Progress has been made in several key areas including birth registration, an increase in the median age of child marriage and a reduction in child labour in most countries (including those of substantial size such as Brazil, India and Mexico). Support for female genital mutilation/cutting has also declined significantly in some parts of sub-Saharan Africa.
issues being institutionalized as policy priorities and governments being given mandates and resources to achieve clear goals. In the case of Brazil, for example, political will led to wellresourced programmes for children. These programmes were considered ministerial priorities. They had strong accompanying mechanisms to strengthen accountability to citizens (see Box 5). The fact that the fight against HIV and AIDS has mobilized political will and leadership globally has led to significant resources for prevention and treatment and to technical innovations such as the new generation of highly effective drugs. Even more importantly, these resources and innovations have been used in well-targeted ways. For example, a focus on critical issues such as preventing mother-to-child transmission has been shown to be highly cost-effective.
A supportive environment In most cases where progress has been achieved on a significant scale and been sustainable over the years, the leading role of the state has been key, either in terms of providing direct policy support, creating an enabling environment, financing initiatives or allowing the space for NGOs and donors to fill gaps in government provision. There have been
impressive increases in exclusive breastfeeding, for example, in countries where parliaments have passed laws on issues such as maternity protection for working women and the marketing of infant formula challenging established practices and, at times, powerful business interests. As change for children does not happen in the very short term, sustainable commitment for continued support to programmes over the medium and long term needs to be retained across political cycles/terms. Non-Governmental Organisations (NGOs) have been important in developing innovative approaches to reduce social or financial barriers to service use. When given access, they have helped extend service provision particularly in geographically isolated areas and to socially marginalized groups. Their advocacy has played a positive role in making private sector services an important part of the overall service delivery. Economic growth Improvements in child well-being have generally occurred during or following periods of economic growth, as periods of growth tend to make greater resources available overall. Without growth, extending and maintaining access to services and quality improvements can become difficult, requiring hard choices in allocating limited funds. Yet, while growth tends to help foster aggregate progress, it does not always narrow the gaps between the poorest and the richest, and it may leave the very poorest behind. Indeed, as already noted, growth is not sufficient on its own but must be accompanied by multi-faceted programmes and the dedication of both financial and human resources to achieving goals. Governments may also need to take measures to tap the increased wealth generated by growth for example, by improving the efficiency of revenue collection so as to capture a greater share of the benefits and use it for social progress. Comprehensive policies for child well-being Countries with comprehensive and holistic policies and strategies that address the multidimensionality of child poverty including their human, social and emotional well-being -
are more successful in advancing childrens rights and needs than countries with piecemeal approaches. For example, it is difficult to help children without addressing the challenges of their caretakers and environments. Having a range of policies in place on different areas of social well-being for households, particularly focused on children, can fuel progress across most child well-being indicators as shown by the example of Viet Nam (see Box 6).
Understanding how successful programmes are designed and implemented is key to making sure that children benefit from policies aimed at improving their well-being such as free or lowcost basic health-care services, maternity benefits and the availability of affordable childcare that enables both parents to work. Social protection measures are increasingly gaining recognition as tools that can reduce child poverty as they commonly address social vulnerability and take into account the interrelationship between exclusion and poverty. Action on reducing inequities, including gender inequality Progress in child well-being has often been greatest where there has been an explicit emphasis on directing resources to and improving the situation of the poorest and most marginalized groups. While conventional wisdom has been that more lives are saved, protected and enhanced in poor countries by
focusing on those individuals that are closer to the poverty line, or closer to meeting a particular development target, there is evidence that this is not always the case. Important gains can be achieved by focusing on the most vulnerable and marginalized because, for example, excluded populations within countries generally have a larger proportion of children owing to higher fertility rates, or a higher proportion of children in these groups die of preventable or treatable diseases. Examples in the report of equitable development strategies where improvements have been concentrated among the poorest include Brazil and Viet Nam (see Boxes 5 and 6). Promoting gender equality and empowering women (MDG3) has also been a driver of child development progress in different ways. Some examples include improvements in girls education rates, which have been critical to improvements in child health, nutrition and child protection, and preventing childbearing until young women are fully grown, which can play a crucial role in improving maternal nutrition and reducing low birth weight. Adequate resources and cost-effective programmes Progress has generally required significant financial investment. In most cases, additional resources have come from a combination of more investment by national governments and increased aid. The share of national income spent by low-income countries on education, for example, rose from 2.9 to 3.8 per cent between 1999 and 2009, and per capita spending on education rose in every region. Public spending on education in sub-Saharan Africa increased by 29 per cent between 2000 and 2005. Three quarters of this increased investment was the result of economic growth with the rest attributable to more efficient taxation and a redistribution of budgets in favour of education. Effective programmes need to be affordable in a sustained manner, and this has to be part of their design. Increasingly governments and donors are seeking to invest resources in programmes that can yield positive results within a manageable level of costs. Research cited in the report shows that an equity-based
approach is cost-effective in achieving crucial child development objectives. Progress in transparency in the use of public funds and in the evaluation of interventions has also enabled a better overall use of resources. For example, evaluations of conditional cash transfer programmes, which originated in Latin America, have shown them to be effective in helping people pull themselves out of poverty and improving childrens lives. This evidence has been used for the design of cash transfer programmes elsewhere.
with the greatest needs and has been effective in reducing HIV rates among children. Analysis in the report suggests that (outside Southern Africa, where the HIV burden is highest) an additional cent per capita in aid dedicated to fighting HIV results in an annual decrease of 0.2 infected children per 1,000 of population. Another example where it is clear that development assistance has made a difference is that 63 countries now have 90 per cent immunization coverage for major preventable childhood diseases, as compared to 12 in 1990. The formation of the GAVI Alliance in 2000 has led to the mobilization of substantially more funds for the introduction of new vaccines and increased coverage of longer-standing vaccination programmes. International support has also been important in enabling developing countries to expand educational provision, train and deploy more teachers, abolish school fees, enact curriculum reforms and improve quality as in Ethiopia (see Box 7).
services that can be improved and scaled up. In addition, donors often foster knowledge sharing and provide technical support such as inputs for design and impact evaluations that can contribute positively to programme implementation beyond financing.
Box 7: Rapid and equitable expansion in primary and secondary education in Ethiopia
More children are attending school in Ethiopia due to increased spending, a massive increase in school facilities, the abolition of school fees, programmes to reach disadvantaged children, action on gender inequalities and efforts to improve quality. Net enrolments in primary education increased from 37 per cent in 1999 to 84 per cent in 2009, with girls rates only 5 per cent below boys. Secondary school enrolment, though low, also increased over the same period and is expected to rise sharply as the greater numbers of children now attending primary school transition to secondary. The Government-led expansion of education has been supported by external assistance.
Overall, it is clear that national investment in several aspects of child well-being, either in sequence or simultaneously, is key and has had strong pay-offs. But external assistance can catalyse progress and strengthen outcomes. Indeed, development assistance works best in contexts where there are national level commitments to pursue child development and there are functional programmes and
to be done to ensure adequate education outcomes, especially for the sort of workplace demands and citizenship skills that can deliver economic payoffs and that are typically acquired with high quality secondary education. Child ill-being is becoming increasingly concentrated among the poorest and most disadvantaged. Worldwide, they are at most risk of early death, malnutrition and not attending school, and in many countries they have been left behind by progress among middle-income and better-off groups. They are also often at the greatest risk of severe violations of their rights, such as abuse and exploitation. Disparities in progress between urban and rural areas, and problems in slums within urban areas, remain daunting, and the needs of the poorest of the poor and those disadvantaged and pervasively discriminated against because of their sex, age, ethnicity or disability must be addressed. Progress for children has been particularly slow in conflict-affected countries. While only 20 per cent of the worlds poor lived in fragile states in 2005, this share is now over 40 per cent and is expected to exceed 50 per cent by 2014. In weak and failed states with governance problems, armed violence and criminal activity (including through gangs) is escalating in rapidly expanding urban spaces and undergoverned spaces with adverse consequences for all, including the young.
All actors governments, civil society, the private sector, international agencies and multi and bilateral donors should draw on the lessons of how these achievements have been made, and work to scale up successful approaches. In particular, greater coverage of well-designed social protection policies have the potential to continue helping to reduce poverty and improve other areas of well-being, especially education, health and nutrition. Successful programmes for children in the future are likely to include social safety nets to prevent households that have broken out of poverty from slipping backwards; the scaling up of cash transfer programmes focused on promoting human development, particularly of children and women, and on pulling the extreme poor out of poverty; or programmes targeted at discriminated minorities or subnational regions that could miss out on the rising living standards enjoyed by others. If such interventions address malnutrition, keep children in school, prevent early marriages of girls and so on, they can break the intergenerational cycle of poverty. A greater focus on equity should be key. UNICEF estimates that MDG4 on child mortality could be achieved much more rapidly by focusing attention on the poorest households, which have the highest rates of child deaths. In 15 low-income, high child mortality countries, a focus on the poorest could reduce up to 60 per cent more deaths for every $1 million invested than the current approach.2 Save the Children has also argued that if the 42 developing countries that account for over 90 per cent of child deaths all took an egalitarian approach to cutting under-five mortality, and made progress across all income groups at the same rate as for the fastest-improving income group, an additional 4 million child deaths could be averted over a 10-year period.3 Technology and innovation offer the opportunity for multiplied impact, and for greater efficiencies and accountability along the spectrum of development work. More children can be treated if markets are shaped to create more affordable, available vaccines. Technologies like the internet and mobile phone networks can
provide access to information (and thus education, and thus opportunity) to the most remote and underserved communities at a scale that was impossible just a few years ago. The growing capacity for local innovation and local development of solutions to global problems is a true, scalable, driver of change. All this means that greater mobilization of resources and action is needed both from a moral and child rights perspective and because the economic and social pay-offs are great. Healthy, educated children are key to the future of all nations; those marginalized and left behind will threaten it. With new technologies connecting even the most remote communities, the poorest today are acutely aware of being left behind, and of missing out on larger societal gains. The goal should be to extend the achievements made to every part of the world, and to each and every child.
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1
The draft for public consultation and comment is available at http://www.unicef.org/socialpolicy/index_59577.html. The final report will be launched in early 2012.
2 3
Narrowing the Gaps to Meet the Goals (UNICEF, 2010) is available at http://www.unicef.org/publications/index_55927.html. A Fair Chance At Life (STC, 2010) is available at http://www.savethechildren.org.uk/en/54_12454.htm.
Published by the United Nations Childrens Fund in partnership with Save the Children UK For more information contact msa@unicef.org United Nations Childrens Fund 3 United Nations Plaza New York, NY 10017, USA www.unicef.org United Nations Childrens Fund (UNICEF) November 2011
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